Darian Leader lives and works in an elegant Georgian house in Clerkenwell – and yes, there is a couch in his consulting room: it's made of chrome and black leather. Do all his patients use it? No. Leader is a Lacanian analyst, which means, among other things, that his sessions are of variable length and frequency, and that it is up to the patient who sits (or lies) where. Leader says he would happy to see a patient on a bench in the square outside, if it seemed like a good idea at the time. For the record, I sit on a chair directly opposite him, trying hard not to be distracted by the somewhat forbidding names (Freud, Klein, Winnicott; all the greats are here) on the spines of the hundreds of books that surround us.
Are you aware that your writing is growing progressively darker?
Yes. My partner [Mary Horlock, a former Tate curator, with whom he has two children] said to me: You used to write these amusing books [eg Why Do Women Write More Letters Than They Post?], and now it's all death and madness. The madness book isn't easy to read, I know, but I find it quite hopeful. At least it shows where things can be done.
In the book, you make a distinction between "being mad", and "going mad". Why is this important? And how can we learn from what you call "quiet madness", or "private psychosis"?
We don't do it enough in this country, but when someone is hospitalised after they have had a psychotic episode, the emphasis should be on what kept them stable for the decades before. Through finding that out, you can discover more about the mechanisms that allow people to keep an equilibrium. These can be crucial clues to help you to enable them to rebuild.
So is your feeling that there is more madness out there than we know?
Yes. I think it's the rule rather than the exception; everyone is trying to cobble their lives together as best they can. Once one recognises this, hopefully it can also work against the stigma and marginalisation [of the mentally ill]. A lot of people find ways of avoiding situations where a trigger [for the madness] is likely to occur. At some level, they know what to avoid, and they organise things in their own unique way to allow them to get through life.
In your book, you use the example of Harold Shipman as an example of a man who appeared perfectly "normal" to his colleagues and patients. Is your position that the murders he committed might not have happened had it not been for certain "triggers"?
Not really. I was trying to ask questions. I was so horrified at the way in which [after Shipman was convicted], even in the world of so-called mental health, you suddenly had people coming out with all this quasi religious stuff. They talked about "pure evil". I wondered what had generated this kind of reaction, what problems there were in thinking about the case. Shipman is an extreme example, but I think we can learn quite a lot from his case – in particular, the way he identified with being a doctor, with the position that gave him in society. For him, it was an anchoring point.
You also write about phobias, how they can be symptoms of psychosis. Isn't this rather a big leap? Can't a phobia just be a phobia?
In the modern world, a phobia is a phobia. But in old [early 20th-century] psychiatry and psychoanalysis, a phobia is a sign of something else. The old psychiatry advised caution when it came to getting rid of a phobia because it might be an elemental way for the patient to partition the world. The clinic is filled with cases of people who get much worse when their phobia is removed. That's a clinical fact.
Aren't you frightened by all this madness? In your book, your tone is preternaturally calm.
Well, any human contact can be frightening [laughs]. All the ads on television seem to involve someone coming to your house, and you have to have an air freshener to hand, or a cup of instant coffee; they're about finding a barrier to put between you and another person. But what's wrong is the very frequent association of madness with violence and transgression, an association that is fostered largely by the media.
But still, how do you live with your work? You told me earlier that the only thing your patients have in common is their suffering, the fact that there is something unbearable in their lives. How do you close the door on your consulting room, and get on with the rest of life?
People ask me this a lot. The main thing [that helps] is one's own therapy or analysis. So you have an idea of why on earth you want to do the job. I always think that the best shrinks are not those who say: 'I want to be a shrink', but those who have had unbearable suffering in their own lives and then, years later, think: 'I'm curious about other people, too.' No serious shrink would accept a patient who was only coming because having an analysis themselves was a necessary part of their training.
How did you become interested in being one?
In my teens, stuff happened in my family. My parents split up. That precipitated an interest in analysis. What made people stay together, or leave each other? At school, we had a good library, but there was one shelf where you had to get permission to take the books out: it had Frazer's Golden Bough and the Collected Works of Sigmund Freud on it. That was the shelf I gravitated towards. To me, it was amazing, like opening a doorway to another world. At Cambridge, I did English and then I swapped to philosophy, and I couldn't understand why no one on either course was interested in talking about psychoanalysis.
Isn't psychoanalysis only for the rich?
That is so not true. At shrink conferences, most people can't afford to pay the entrance fee. In my group, people pay what they can afford. I have some people who pay five pounds. If you need to earn a certain amount of money per month from your practice, you shouldn't do the job. That's why most shrinks have other jobs, too. I trained in Paris, and I had lots of jobs there. I was a gardener, I waited tables, I taught English to the Parisian shrinks.
Do you find yourself secretly diagnosing everyone you meet?
No. In any case, when I meet people, and I tell them what I do, either they get incredibly aggressive because they or a friend has had a bad experience, or they tell you about their dreams, about how they were chased by a shark of something.
What about your children? Has being an analyst had an effect on the way you parent?
Actually, it has made me more sceptical of traditional analytical theories about babies. To say, for instance, that a baby's only relationship is with the breast is just ridiculous; there's so much going on. We know very, very little about kids. But then, the early analysts didn't have children, or if they did, they had nannies.
Have you seen In Treatment [the American TV series, in which Gabriel Byrne plays a shrink]?
I've got dozens of box sets upstairs [laughs]. Everyone gives it me as a present. I really wanted to like it, but I'm afraid that I found it unconvincing, and not particularly interesting.